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Personal Injury Claim Settlement

Evaluation of the bodily injury claim

Is your personal injury claim settlement offer fair? To be able to answer this question, you need to learn how to evaluate your claim and injury.

If you understand how most insurance companies evaluate a claim, then you will see how the settlement negotiations will develop.

Early on in the claim process, insurance adjusters will give you a medical authorization form. These forms give them the power to request all your medical history.

You could request to soften the language of these forms so they can only see the medical history that is related to the accident, nothing else.

The adjuster will review all your medical history. I mean they will go line per line picking items that will help their case. They will mainly be looking at your doctors’ notes.

Any indication that you are getting better, that you had a prior injury, or that something else happened that aggrieved the injury will be carefully noted.

Adjusters will also look at those notes that will hurt their case, any indication that the injury is permanent or that it could be argued that it is permanent will be also noted for final evaluation.

It is very important when seeking a fair personal injury claim settlement to read your entire medical file yourself. You need to find out exactly what the doctor wrote, so her words cannot be twisted into something that can harm you. This is why you need to be very careful with what you say to any medical provider.

These individuals write every single thing you say. If you tell them that you are standing up at your work place all day long, then it will be noted. The adjuster will pick up on that and later argue that some of your injury could be attributed to the fact you stood up a lot at work.

I cannot emphasize this enough. Everything you say, even in the ambulance is noted, jokes included. Medical records will reveal everything you say. So when the adjuster looks at comments, she will be looking to document that you are doing better than you are really telling them.

The best way to ensure that you get a fair personal injury claim settlement offer is by reading your own medical file. Ask the adjuster for it. They will send you copies of what they are looking at.

Once the adjuster reads the entire file and weighs the pros and the cons of your case, they will set up a treatment calendar. They will print a calendar from the date of the accident until the current day.

They will “map out” every single day that you went to the doctor. They want to make sure that there are no big gaps in treatment.

Gaps in the treatment period will hurt your settlement. The insurance carrier considers gaps in the treatment as evidence that you were not injured as bad as you are arguing.

If you were hurt, then you would be going to the doctor. However, gaps in the treatment period are tricky to dispute and to argue around. If you have gaps in treatment, I recommend you get this Personal Injury eBook.

Too much treatment could show that you are treating unreasonably. Insurance adjusters see trends of treatment. A “normal” soft tissue injury has an average treatment anywhere from four to five weeks.

Usually treatment begins three times per week and gradually works its way to a few times per month.

Evaluating trends like this one helps the insurance company determine who is “over treating”. They can see which doctors are having you see them more than what it is normally required.

So when evaluating a bodily injury claim, the nature of the injury is as important as the treatment calendar.

Treatment will show that your injury was bad enough that you had to go to the doctor. If you do not go to treatment, then they will argue that your injury did not require you to go in. However, we can see where there are many problems with this approach.

Many people cannot get out of work to go to the doctor (cannot lose their wages, or simply their work does not allow them to go). Not seeing a doctor does not necessarily mean that they are not injured.

However, not being able to show evidence that an injury was severe enough to require medical treatment will cripple any case in a court of law.

The next step before the settlement negotiations starts is a close study of the jurisdiction where the case would be heard on.

How much do juries award in that jurisdiction? What is the average personal injury settlement for the same injury with the similar amount of treatment? Some jurisdictions are very liberal when paying for bodily injury claim.

They will award a lot of money for not that much treatment. Other jurisdictions are very conservative and feel that insurance companies get taken adventage of by frivolous lawsuits.

Either way, the insurance adjuster knows that she needs to adjust their personal injury claim settlement amounts so they reflect the jurisdictional aspect of the juries’ award.

The evaluation of the claim does not stop there. Claim adjusters must take into account the reputation of the doctors and attorneys.

A good attorney could move the adjuster to make a more attractive first offer, and a respectable doctor’s testimony could add significant value to your personal injury claim settlement amount.

As you can see, an insurance adjuster looks at many factors before “making a call” about the value of the claim, and they give themselves a range of settlement. What is the minimum amount a jury would award? And what is the maximum? In soft tissue injuries, this range is anywhere from $500 to $8,500.

For example, if the claim adjuster believes that the minimum amount your personal injury claim is worth is $2,000, then the opening offer will be $2,000. They cannot offer you less than that. There are regulations that forbid insurance companies from settling a claim for less than the value of their bottom range.

A settlement below the low range originally set by the adjuster would be strong evidence of bad faith against any insurance company. The problem is that insurance adjusters really have all the discretion to set the range and you rarely know what the “real” bottom range was.

They can just make the bottom range lower and then offer that. There is really not much regulation about setting these ranges.

Before the personal injury claim settlement negotiations start, the adjuster will review your medical history for prior injuries and for more “evidence” against you. After all of the above, the first offer is made.